Incidence and outcome of isolated distal deep vein thrombosis in kidney transplant recipients

PURPOSE: Isolated distal deep vein thrombosis (IDDVT) is a localized lesion; nonetheless, the risk of proximal vein propagation makes it difficult to decide on the treatment protocol—that is, whether immediate anticoagulation after diagnosis or surveillance via serial imaging should be employed. This study aimed to investigate the appropriate treatment protocol for IDDVT in kidney transplant recipient (KTR). METHODS: Surveillance for venous thromboembolism (VTE) was performed using duplex ultrasonography (DUS) before transplant surgery and at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after transplant surgery. Dual mechanical prophylaxis was administered to prevent VTE. RESULTS: In total, 60 out of 829 patients (7.2%) developed VTE, with 49 cases (81.6%) of IDDVT. Among IDDVT patients, 15 patients were treated using anticoagulation-first strategy, whereas the remaining 34 patients were treated using surveillance-first strategy. No patient in either group exhibited thrombus extension into the proximal vein or recurrence within 1 year from transplant surgery. CONCLUSION: In Korean KTR, extension of IDDVT into the proximal vein could be prevented safely and effectively by serial DUS surveillance along with the maintenance of mechanical prophylaxis. However, the patients who have high thrombus burden or are difficult to get repeated DUS require the use of anticoagulation in early stages.